San Francisco is getting national attention for its attempt at universal health care. President Obama even applauded the city's efforts in a speech: "Instead of just talking about health care, [San Francisco has been] ensuring that those in need receive it."
But Healthy San Francisco a pioneering effort to do at the municipal level what the federal and state governments won't is running into some troubling problems, made worse by Mayor Gavin Newsom's budget cuts.
The program was initiated by Tom Ammiano, now a state assemblymember, with backing from organized labor. Ammiano's goal was to provide easy access to affordable health care for all of S.F.'s 60,000 uninsured. A local version of a single-payer program, he argued, could provide accessible primary and preventative care, alleviating the need for indigent patients to use the overcrowded and expensive San Francisco General Hospital emergency room as their primary medical provider.
Healthy San Francisco was launched on July 2, 2007, at two Chinatown clinics. It has grown dramatically, and now provides services to more than 34,000 residents at 27 clinics.
Although Newsom sat on the sidelines while Ammiano pushed the legislation, the mayor has now unashamedly claimed the program as his own to promote his gubernatorial campaign. On his Web site he boldly declares that "he's created the only universal health care program in the country" with no mention of Ammiano.
The $200 million-<\d>a-<\d>year program is partially funded by an employer-mandate requiring businesses with more than 20 employees either to provide health insurance or pay a fee to the city. The fees are broken down according to the size of the business; as of January 2009, employers pay between $1.23<\d>$1.85 for every hour an employee works.
Like any traditional health insurance program, Healthy SF has annual fees and point-of-service charges paid by participants. The remainder of the program is funded through state grants.
Opposition to HSF surfaced immediately. The Golden Gate Restaurant Association sued the city even before the program started, alleging that the employer-spending mandate is a violation of federal law.
Kevin Westlye, the association's executive director, claims his beef is not with the health care system, just with the employer mandate. He suggested that the city raise its sales tax to pay for the program or that the financial burden should fall on the backs of the billionaires that run privatized health care and pharmaceutical companies.
But the city has only a limited ability to raise taxes, and any tax hike would require voter approval. The employer mandates and fees were much more politically feasible.
Deputy City Attorney Vince Chhabria, who is representing the city on the case, argues, "It is difficult to imagine, in these budget times, that San Francisco could provide universal coverage without employer health care spending requirements."
Federal courts sided with the GGRA initially, but the Ninth Circuit Court of Appeals agreed that the employer-spending mandate was legal. The GGRA appealed to the United States Supreme Court; the court will announce Oct. 5 whether it will hear the case.
That's not the only litigation facing HSF. A group of low-income residents are suing the city, saying that the system's annual fees and co-pays are too high. The program's fees are scaled to the federal poverty level, which is currently set at an annual income of $10,830. A single person making between 101 percent and 200 percent of the federal poverty level that is, between about $11,000 and $20,000 a year pays $180 a year for HSF membership.